Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 31016 | CA |
Y | 213EG0000X | General Practice | 31016 | CA |
NPI | 1003916214 |
---|---|
Provider Name | Gary Wirtschafter |
First Address | Culver City, CA 90232-2729 |
Second Address | Culver City, CA 90232-2729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 08/07/2007 |